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3. Y5 Zero to finals: O&G > PPH > Flashcards

PPH Flashcards

1
Q

What is the classification of PPH in NORMAL delivery?

A

500ml +

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2
Q

What is the classification of PPH in C Section?

A

1000ml +

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3
Q

What are the different severity classifications of PPH? (3 things)

A
  1. Minor PPH: Under 1000ml
  2. Major PPH: 1000-2000ml
  3. Severe PPH: 2000ml +
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4
Q

What is the different TIMING classifications of PPH? (2 things)

A
  1. Primary PPH: Within 24 hours of birth
  2. Secondary PPH: from 24 hours – 12 wks after birth
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5
Q

What are the causes of PPH? (4 things)

A
  1. Tone (uterine atony aka no tone) (most common cause)
  2. Trauma
  3. Tissue (retained placenta)
  4. Thrombin

(4 T’s)

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6
Q

How does Uterine atony cause PPH?

A

Lack of tone in uterine muscle –> uterus can’t contract properly

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7
Q

What are the types of Trauma that cause PPH?

A

Vaginal / Cervical / Perineal tears

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8
Q

What are the RF for Trauma causing PPH? (3 things)

A
  1. Instrumental delivery
  2. Episiotomy
  3. C section
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9
Q

How does a retained placenta cause PPH?

A

Stops uterus from contracting

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10
Q

What does Thrombin refer to as a cause of PPH? (2 things)

A
  1. Vascular abn
  2. Coagulopathies
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11
Q

What Vascular abn cause PPH? (3 things)

A
  1. Placental abruption
  2. HTN
  3. Pre-eclampsia
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12
Q

What Coagulopathies cause PPH? (3 things)

A
  1. von Willebrand’s disease
  2. Haemophilia A/B
  3. DIC
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13
Q

What are the RF for PPH? (12 things)

A
  1. PPH Hx
  2. GA
  3. Obesity
  4. Multiple pregnancy
  5. Large baby
  6. Failure to progress to 2nd stage of labour
  7. Prolonged 3rd stage
  8. Pre-eclampsia
  9. Placenta accreta (grows into uterus wall)
  10. Retained placenta
  11. Episiotomy / perineal tear
  12. Instrumental delivery
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14
Q

Apart from the obv bleeding, what other CF can you get if substantial PPH? (4 things)

A
  1. Dizziness
  2. Palpitations
  3. SOB
  4. Haemodynamic instability
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15
Q

What might you see @ Abd examination of PPH?

A

Signs of uterine rupture (aka fetal parts as it moves from uterus –> abd)

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16
Q

What might you see @ Speculum examination of PPH?

A

Local trauma sites may be revealed

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17
Q

What should you examine after PPH? Why?

A
  • Placenta
  • To ensure placenta is incomplete
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18
Q

What causes of PPH might you see @ Placenta examination? (2 things)

A
  1. Missing cotyledon
  2. Ragged membranes
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19
Q

What is the pneumonic for the Mx plan for PPH?

A

TRIM

20
Q

What does TRIM stand for as the Mx plan of PPH? (4 things)

A
  1. Teamwork (Immediate)
  2. Resus (ABCDE) (Immediate)
  3. Investigations + Monitoring (Immediate)
  4. Measures to arrest bleeding (Definitive)
21
Q

Who is involved in the Teamwork aspect of PPH Mx? (6 things)

A
  1. Obstetricians
  2. Anaesthetists
  3. Haematologist
  4. Midwife in charge + Midwives
  5. Blood bank
  6. Porters
22
Q

What Investigations should you for PPH? (5 things)

A
  1. FBC
  2. Cross match 4-6 units blood
  3. Coag profile
  4. UnEs
  5. LFT
23
Q

How should you Monitor a PPH? (5 things)

A
  1. RR
  2. O2 sats
  3. HR
  4. BP
  5. Temperature
24
Q

How often should you do the Monitoring things for PPH?

A

Every 15 mins

25
Q

What else should you consider for Monitoring PPH? (2 things)

A
  1. Catheterisation
  2. Central venous line insertion
26
Q

What are the Definitive Mx option titles for PPH? (3 things)

A
  1. Mechanical
  2. Medical
  3. Surgical
27
Q

What are the MECHANICAL Mx options for PPH?

A
  1. Rubbing uterus (thru abd)
  2. Catheterization
28
Q

How does Rubbing uterus work to manage PPH?

A

Stimulates uterine contraction

29
Q

How does Catheterization work to manage PPH?

A

Reduces bladder distention

(which was preventing uterine contractions)

30
Q

What are the MEDICAL Mx options for PPH? (5 things)

A
  1. Oxytocin
  2. Ergometrine (IV / IM)
  3. Carboprost (IM)
  4. Misoprostol (subling)
  5. Tranexamic acid (IV)
31
Q

How should Oxytocin be administered in PPH Mx?

A

Slow injection then continuous infusion

32
Q

How does Ergometrine work in PPH Mx?

A

Stimulates SMC contractions

33
Q

When is Ergometrine CI for PPH Hx?

A

HTN

34
Q

What class of meds are Carboprost + Misoprostol?

A

Prostaglandin analogue

35
Q

How do Carboprost + Misoprostol work in PPH Mx?

A

Stimulate uterine contraction

36
Q

What class of meds is Tranexamic acid?

A

Antifibrinolytic

37
Q

How does Tranexamic acid work in PPH Mx?

A

Reduces bleeding

38
Q

What are the SURGICAL Mx options for PPH? (4 things)

A
  1. IU balloon tamponade
  2. B-Lynch suture
  3. Uterine artery ligation
  4. Hysterectomy (last resort)
39
Q

How does IU balloon tamponade work in PPH Mx?

A

Insert inflatable balloon into uterus to press against bleeding

40
Q

How does B-Lynch suture work in PPH Mx?

A

Putting suture around uterus to compress it

41
Q

How does Uterine artery ligation work in PPH Mx?

A

Ligate 1+ arteries supplying uterus to reduce blood flow

42
Q

How does Hysterectomy (last resort) work in PPH Mx?

A

Stops bleeding + saves woman’s life

43
Q

What are the causes of Secondary PPH (24 hrs – 12 wks)? (2 things)

A
  1. Retained products of conception (RPOC)
  2. Inf (e.g endometritis)
44
Q

What investigations should you do for Secondary PPH? (2 things)

A
  1. US (for RPOC)
  2. Endocervical + high vaginal swabs (for inf)
45
Q

What are the Mx options for Secondary PPH? (2 things)

A
  1. Surgery (for RPOC)
  2. Abx (for inf)
46
Q

How do you prevent PPH even happening in 1st place? (4 things)

A
  1. Treat anaemia during antenatal period
  2. Give birth on empty bladder
  3. Active Mx of 3rd stage (w IM oxytocin)
  4. IV Tranexamic acid in C section for high risk pt

3. Y5 Zero to finals: O&G (27 decks)

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